Univita Health, an innovator in extending the reach of care management into the home, announced the national expansion of its evidence-based Bridges transition care program to support at-risk patients transitioning from the hospital to home. The program’s home-based services and care coordination are designed to improve patient outcomes and reduce costly readmissions in line with the recently enacted Hospital Readmissions Reduction Program (Section 3025) under .

“In partnering with health plans, we have seen success at reducing hospital readmissions by more than 30%. By expanding our transition care services to directly work with both hospitals and health plans throughout the United States, we are even better positioned to bridge the gap in care between the hospital and the home,” said Dr. John Mach, president of Univita’s complex case management division. “The ability to expertly manage a patient’s medical, cognitive and functional needs in the home has proven to be effective in promoting a full recovery and reducing hospital readmissions.”

With the program expansion, Univita has collaborated with major health plans like Aetna and Coventry Health Care of Kansas, as well as world-renowned hospitals, including Cleveland Clinic's Program for Advanced Medical Care, a program for self-insured companies that brings patients from across the country to the Clinic for complex surgeries. These collaborations provide qualifying patients across the United States the ability to receive medical care at a hospital and then complete a coordinated recovery process in the comfort of their own homes.

Working jointly with hospital medical staff and the patient’s health plan, Univita’s specially trained nurses consult with each patient and their family preceding the surgery, as well as in the hospital post-surgery to confirm understanding of the medications, discharge materials and follow-up instructions. Once patients are ready to leave the hospital, Univita will leverage its national network of nurses to visit with them in their home, perform a comprehensive assessment, and oversee an interdisciplinary team of physicians, nurse practitioners, therapists, pharmacists and social workers to coordinate the medical and non-medical care needed for them to remain at home.

“For patients, this expansion ensures that the medical attention they receive extends beyond the hospital and into their homes, from the moment they step in their front door and each day during the recovery process,” said Jean Haynes, president and chief executive officer of Univita.

Univita is an innovator in providing home-based care management, extending the reach of care management into the home. Our comprehensive approach addresses and manages the complete array of a patient’s care needs, encompassing both clinical and non-clinical drivers of health outcomes. Univita supports the care management efforts of health plans, insurers, health systems and physicians with a focus on the highest risk, most complex populations. To learn more, visit .